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01050153 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS. PHRMI'I'No © Q5O S3 0 3 2 OWNER'S NAME: APPLICATION SUIt DAT[ O PHONE: SANITARY NO. COMHOL NO. as-7 o �O C rc% ARCIIITfiCI/IiRGINEI!H: HU1LDIN ,PERMIT INFO O �u_ � BLDG F:LECI' I'LUM11 MECH Ga y= LICE hat IU CONTRACTOR'S DECLARATION Job Description herehY adiun Ihn,1 ren of he B nines previsions of Ch Cod 9lIII try cncing F==� with Senionr kind of Uivimion3oftM1C Business and l'mfcxsions Code unJ try ll¢n,c s Yy� elull la nil dlcd. z an¢ IJttnxc Class hie.M O O Ilam Contractor ¢j 3 a h ARCH fl IT S DECLARATION ' F u O a 1 undemmd Iny plan,,n!l h' usad as public rccnNs f c OO Linnsnl Professional OWNERBUILDERDECLARATION 1 hereby offim,that am exempt fmm,he Central License Law for the following masm.(Scene.7031.5.Business and Pmfessicw Crdc:Auy city or mm�,y E 2 C which requires a permit,n construct.alter,improve,demolish.or repair any aracmm W3= prim m its i,swnce.also"dims the applicant for such Permit file a signed smumben, ma,het.Rcensed pursuant to the pmv,.ions of ceremonies License Lew(Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7005)of Division 3 of the Business and Professions Cade) O r that he is exempt nccmfmm and the basis for the alleged exemption.Any vitiation of Section 7031.5 by any applicant for a permit subjects the applicant,o a civil Nually of mat more than five hundred dollars($50)> [A PN Number Occupancy Type ❑I,mnwner of the prupemY,nrnryemployecs with wagesmlhoinnlc en,npcnsmion, s+ will do the work,and the structure is not intended or oll'ered for vole(Sec.7(OWL Business and pmrcssimnv Code:The Contractor License Law does nor apply ,,un Required Inspections tooper at property Who hnild,or improves thereon,and who docs such work hunwlr I,thmugl,his awn employees,pnrvitled that such improve col,are not intended in nlL'red fir sale.11,howovor,the but Wing or ing,r)vnvcut is,old willlin ane year a1' ' imlplction,the ow'ncrbuilder will Iavc Om burdenof noving,hal hedid nut ouldnr improve III,pogm v II sale.). ❑1,as owner nl'the property,am exclusively contme,ing will,licensed contn¢Inn n, nstroc,the p,,jc,i(sus.7(94.Bus nil Pmfes s Ctde:)The Cn onsoo,'s Licsmw Law,does not apply to an owner of property who builds or in,pmvcu,hcreon. and who contmcrs for such projects with a carompmgx)licensed pursuant r,the rAlam is License Laws FINALE D �Ir�I� u SKr�1 Em AT[ CLAAT�)NCIntthis rcus„n MAY 2 2 2001 1 herby affirm under penalty of perjury one of the following dalure,ions: • 0 1 have and will maintain a Cerilicam of Consent to scl6insure lot Worker's BUILDING Cnmpensmion, ;is provided for by Section 3703 of the Labor Crile. for ,he performance of the xnrk for ahich this permit is issued. and oi will,nain, n Worker's Compensation Insurance,as required by Section 111 of the will Crdo,to,,he pem'omamer of the work fur which this permit is sued,My Workkeer's C000lvensainon Insurance wrier wd Policy nn,nhenare '. Caldc,: - tPblPulicy Nu.: —CL'R'fII CATION OIn hrF.MPN o': i'ROM WORKERS' QIMPENSATION INSURANCE ('I his cation recd as h completed if the permit is bur one handed Anllurx (8101)nr Ins.l 1 certify that in We petfnm,ance of the work for which this permit is issued.I shall nor nnploy any person in any manner so as to have I,subject its the Workepi Compenceion Law,of California.Date ' Applicant NCI ICE TO APPLICANT':IL afar making this Casifiame or It a npdon,pm should becomesubject m the Workers Compensation provisions of rhe Livor Cale,you most Q O forthwith comply with such provisions or this permit shallM deemed revoked. - CONSTRUCTION LENDING AGENCY ^1 7 I hereby adimtrod them is a cnnswc,iun lending agency far the performance fa7 of the work for which this permit in i:wed ISce.301 Civ.C.) 0. Q Lida:Name Z Lender's Address L..) 0 1 acetify that I have read this applicaron and xhde had the aMwc information is W py vo rresa.I'ngmo h.enn,ply with all city and county nNlmanecs and,tate laws chitin, O O m building enmmua,Itn,I Ihembyarm encp,ewnta s,ol did,city m eniorupmI �yIlse uhnvwncntionelpmpnty for bnpecion pu,ynscs. W Q. (ii 6 I Tl ould k id,IIIIII anyhe a c, 1 l urn b'In,I z lith li e 'h Y any "Y' y:'in.l m,iA C� rZa Cl,ylu,nnp stet.nl the Er.nngnfthis per,i t. API CA%NT UNDP STANDS AND W .L COMPLY WITH AI.1.NON�POINr Issued b Date S(l ai RliGlll. I(b �Q_ y' g'gnawre nl pNiaa,mcni ctnr ^`1%ad �— Re-roofs IIAZARDOUS h1ATER1A4S DISCLOSURE . Willrhe applicam.e future building ocepere some,in handle hvaNams nmmnal Type of Roof as defined by the Cupertino Mopal Code.Chapter 9.12,and the Hedlh and SafetyEde.Section 255R(n)] Elyca Oil All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection. I agree to remove emit hurmdow air cnnamiremp defined by,he Bay Arca Air Quality Marngemenr uL.marr \ all new materials for inspection. Applicant understands and will comply with oyes \7No all non-point source regulations. 1 have rend,he hanNous mmenals requirements muter Chapter 6.95 of the Calif on,ia realm k Snl'cty Code.Sections 25505.25533 and 25514.1 mdcr,nmd that it the Flolding'Joe'net anrrvnlly have a emouL Lan it i,,,,y respunsibiliry m natty,he aora nfm,ne 'he raqui ,t.s which n be n¢I prior to i,vnnc uc tl n Ccnllicntc of r vco any. n ..g,–(� ^ — Signature of Applicant Date Dwnern7"b rte Dam All roof coverings to be Class "B" or better OFFICE